/ State of Utah
Department of Technology Services
1 State Office Building, Sixth Floor
Salt Lake City, Utah 84114
801-538-3666
Security Level Designation and ID BadgeFor Third Party
All Information Required
Third-PartyName:
Photo ID #: / Work Phone:
Project Name: / Length of Project:
Third-Party’s Employer: / Third-PartyEmployer Phone:
(Only Applicable When Given an ID Badge)
I have read and understand the following:
I am responsible for the use of this identification badge and will not loan it to another person. I agree to abide by all DTS policies and regulations set within the secured access areas. I also agree to return the badge when I am no longer employed by DTS and will notify DTS immediately if I lose or damage the badge.
Third-Party Signature: / Date:
Below To Be Completed By Provider's DTS Manager (*All Fields Required)
*DTS Contract Supervisor Justification for Security Level Designation:
*Security Level Designation for Provider (see pages2—3 of this form): / 1 2 3 4
*Agency:
* DTS Contract Supervisor Name: (Print) / Phone:
* DTS Contract Supervisor Signature: / Date:
DTS Enterprise Security Use Only
Issued I.D. Badge #:
Entered By: / Date:
CISO (or designee) Signature: / Date:
Deliver this Designation To: / Department of Technology Services
Enterprise Information Security Office
1 State Office Building, Floor 1, Data Center
Salt Lake City, UT 84114
/ State of Utah
Department of Technology Services
1 State Office Building, Sixth Floor
Salt Lake City, Utah 84114
801-538-3666
Security Levels Information
Standard (Level 1)—A person with a Standard Security designation may have access to one or more of the following items in addition to the items for General Public Security:
  • A Security Level 1 area
  • A state information system with a DTS security impact designation of Low
  • An information asset with a DTS security impact designation of Low
  • A physical asset with a DTS security impact designation of Low
Medium (Level 2)—A person with a Medium Security designation may have access to one or more of the following items in addition to the items for Standard Security:
  • A Security Level 2 area
  • Items of local, state, and/or national security interest
  • State-owned information or information asset with a GRAMA designation of private, controlled, or protected
  • A state information system with a DTS security impact designation of Moderate
  • An information asset with a DTS security impact designation of Moderate
  • A physical asst with a DTS security impact designation of Moderate
High (Level 3)—A person with a High Security designation may have access to one or more of the following items in addition to the items for a Medium Security Position:
  • A Security Level 3 area
  • The administrative functions of a DTS or enterprise information technology system
  • An information system used for the administration of financial accounts or accounting systems
  • An information system used for the care, custody, or control of children
  • An information system used for providing health care to children or vulnerable adults
  • An information asset with a DTS security impact designation of High
  • A physical asset with a DTS security impact designation of High
Critical (Level 4)—A person with a High Security designation may have access to one or more of the following items in addition to the items for a High Security Position:
  • A Security Level 4 area1
  • The administrative functions of an information system or application used for the DTS Security Program
  • Information or information asset used for the administration of criminal justice
  • An information system used for the administration of criminal justice
  • An information asset with a DTS security impact designation of Critical
  • A physical asset with a DTS security impact designation of Critical
Notes:
1. The State Data Center is designated as a Level 4 facility.

Information Continues on Next Page

/ State of Utah
Department of Technology Services
1 State Office Building, Sixth Floor
Salt Lake City, Utah 84114
801-538-3666
Security Impact Information
Low (Level 1)—The potential impact is LOW if a compromise of the functional security requirement is expected to have a limited adverse effect on organizational operations, organizational assets, or the physical or financial well-being of an individual. For example:
  • Degradation in mission capability to an extent and duration that the organization is able to perform its primary business functions, but effectiveness of functions is noticeably reduced.
  • Minor damage to organizational assets.
  • Minor financial loss by the organization.
  • Minor physical or financial harm to an individual
Moderate (Level 2)—The potential impact is MODERATE if a compromise of the functional security requirement is expected to have a serious adverse effect on organizational operations, organizational assets, or the physical or financial well-being of an individual. For example:
  • Significant degradation in mission capability to an extent and duration that the organization is able to perform its primary business functions, but effectiveness of functions is significantly reduced.
  • Significant damage to organizational assets.
  • Significant financial loss by the organization.
  • Significant physical or financial harm to an individual, but does not involve loss of life or serious life threatening injuries.
High (Level 3)—The potential impact is HIGH if a compromise of the functional security requirement is expected to have a severe adverse effect on organizational operations, organizational assets, or the physical, financial, or emotional well-being of an individual. For example:
  • Severe degradation in or loss of mission capability to an extent and duration that the organization is not able to perform one or more of its primary business functions.
  • Improper disclosure of financial system information.
  • Improper disclosure of information governed by the Privacy Act of 1974
  • Severe damage to or loss of organizational assets.
  • Severe financial loss by the organization.
  • Significant financial loss by the state.
  • Severe financial harm to an individual.
  • Severe physical harm to an individual, with potential for loss of life or other serious life-threatening injuries.
Critical (Level 4)—The potential impact is CRITICAL if a compromise of the functional security requirement is expected to have a catastrophic effect on statewide operations or to an individual which will result in the loss of life. For example.
  • Catastrophic loss of mission capability to an extent and duration that the State is not able to perform one or more of its primary business functions.
  • Catastrophic damage to or loss of organizational assets.
  • Catastrophic financial loss by the organization.
  • Severe or catastrophic financial loss by the State.
  • Severe or catastrophic financial harm to an entire class of persons.
  • An expectation for the loss of one or more lives.

I

Information Continues on Next Page

/ State of Utah
Department of Technology Services
1 State Office Building, Sixth Floor
Salt Lake City, Utah 84114
801-538-3666
Agency Assignment Information
Administrative ServicesDAS
Agriculture and FoodUDAF
Alcoholic Beverage ControlDABC
Board of PardonsBOP
CommerceDOC
Community and CultureDCC
CorrectionsUDC
Environmental QualityDEQ
Financial InstitutionsDFI
Governor’s OfficeGO
GO Economic DevelopmentGOED
HealthDOH
Human Resource ManagementDHRM / Human ServicesDHS
InsuranceUID
Labor CommissionLC
National GuardUNG
Natural ResourcesDNR
Public SafetyDPS
Public Service CommissionPSC
Tax CommissionUSTAX
Technology ServicesDTS
TransportationUDOT
Veteran’s AffairsDVA
Workforce ServicesDWS

DTS Form: 516 / Revised: 7/8/2015Page 1